Ensuring Access to Environmental Interventions for People with Asthma: The Environmental Investments Initiative

As a Senior Advisor to the US Department of Health and Human Services and the Environmental Protection Agency during the late 1990s, the Lowell Center’s Polly Hoppin was instrumental in the development of federal strategies to address the growing asthma epidemic.

Her work contributed to the establishment of the Asthma Regional Council of New England, which continues to play a leadership role in bringing asthma under control by coordinating research, policy development and program implementation among federal, state and local health departments and other stakeholders across New England. Between 2000 and 2012, Polly and her colleague Molly Jacobs of the Lowell Center partnered with the Asthma Regional Council in an initiative to integrate environmental interventions—assessment and reduction of environmental triggers in homes and workplaces—into the daily business of delivering and paying health care. Our strategies included:

Research

how public and private insurers make decisions about what services to pay for

current knowledge and practice of health care providers with regard to best practices for asthma management.

case studies of how health departments provide environmental services to people whose asthma is not well-controlled.

Translation of Research

Dissemination of evidence that home visits to people with out-of-control asthma reduce exposure to environmental triggers and improve adherence to medications, resulting in decreased utilization of high-cost health services and improved asthma control.

Business case for insurers that documents cost-effectiveness of home visits for asthma and provides guidance for how to classify patients and target interventions appropriately.

Business case for health care purchasers/employers making the case for a three-pronged strategy for reducing the burden of asthma among employees: incorporating asthma education, including environmental trigger information and workplace exposure information, into wellness programs; expanding insurance to cover home visits for asthma; toxics use reduction for reducing exposures in the workplace.

Insurance check-list to align insurance coverage with best practices.

Synthesis of evidence and recommendations for preventing asthma in health care environments.

Strategic convening of stakeholders for policy change

Provider consensus statement.

Symposia for payers, providers and health departments

These activities led to changes in policy and practice by public and private payers and public health departments in New England, increasing access to home-based environmental services and asthma education by people whose asthma was not well-controlled, and reducing hospitalizations and emergency room visits, and associated costs. They have also helped leverage millions of dollars in state funds to support expansion of asthma home visits, and have contributed to policy change at the national level, influencing both recommendations of a federal initiative to reduce disparities in asthma, and regulations promulgated by the Center for Medicaid and Medicare Systems (CMS).